Abstract
BackgroundThe plasma concentration of patients treated with efavirenz (EFV) 600 mg was found to exceed the upper limit of the proposed therapeutic window in most Chinese HIV-infected individuals; thus, dosage reduction of EFV to 400 mg daily warranted consideration. This study aimed to assess the pharmacodynamics of EFV 400 mg for HIV-1-infected patients in China.MethodTwenty cART-naïve individuals were enrolled in this study. EFV 400 mg combined with tenofovir (TDF) and lamivudine (3TC) as an initial antiretroviral regimen was administered for 48 weeks. EFV concentration and T cell subsets as well as HIV RNA load were evaluated at baseline and at 4, 12, 24, and 48 weeks. Moreover, neuropsychiatric adverse effects were also assessed by the Hamilton depression (HAMD) scale and Pittsburgh sleep quality index (PSQI).ResultsEighteen males and two females whose median age was 26 (interquartile range [IQR]: 23–32) years completed 48 weeks of follow-up. The median EFV concentrations were 1.88 (IQR: 1.54–2.42), 1.74 (IQR: 1.36–1.93), 1.93 (IQR: 1.66–2.22), and 1.85 (IQR: 1.54–2.14) mg/L at weeks 4, 12, 24, and 48, respectively. The viral load was 4.59 (IQR: 4.10–5.19) log10 copies/mL at baseline, and it decreased by 4.6 (IQR: 3.98–5.18) log10 copies/mL from baseline to week 48. Three of 20 (15%), 10 of 20 (50.0%), 17 of 20 (85%), and 18 of 19 (95%) participants had a plasma viral load less than 50 copies/mL at weeks 4, 12, 24, and 48, respectively. The median CD4 cell count was 330 (IQR: 237–410) cells/μL at baseline, and it increased to 473 (IQR: 344–574) cells/μL at 48 weeks. The HAMD score was 5 (IQR: 3–9.8) and 3 (IQR: 2.25–4) at baseline and 48 weeks, respectively. The PSQI score was 4 (IQR: 2–5.8) and 3 (IQR: 2–4) at baseline and 48 weeks, respectively. Dizziness was the most common event, occurring in 70% of patients within the first 2 weeks of treatment.ConclusionPatients prescribed with EFV 400 mg-containing agents demonstrated favourable virological and immunological responses. And the plasma EFV concentration was within the recommended therapeutic range, with fewer adverse reactions than with EFV 600 mg. EFV 400 mg was effective and safe in Chinese HIV-infected patients.Trial registrationNCT04596488; Registered 21 October, 2020; Retrospectively registered.
Highlights
The plasma concentration of patients treated with efavirenz (EFV) 600 mg was found to exceed the upper limit of the proposed therapeutic window in most Chinese HIV-infected individuals; dosage reduction of EFV to 400 mg daily warranted consideration
Nonnucleoside reverse transcriptase inhibitors (NNRTIs), such as efavirenz (EFV), play a key role in suppressing HIV RNA replication [4], and EFV combined with two nucleoside reverse transcriptase inhibitors (NRTIs) is still considered the preferred regimen in many developing countries, including China [5], because of its accessibility and cost efficiency
We aimed to assess the pharmacodynamics of EFV 400 mg in 20 HIV-1-infected individuals commenced on EFV 400 mg combined with tenofovir disoproxil fumarate (TDF) and lamivudine (3TC) as an initial regimen
Summary
The plasma concentration of patients treated with efavirenz (EFV) 600 mg was found to exceed the upper limit of the proposed therapeutic window in most Chinese HIV-infected individuals; dosage reduction of EFV to 400 mg daily warranted consideration. Patients with plasma EFV concentrations > 4 mg/L experienced three times more frequent CNS adverse events than those with concentrations in the recommended range [10]. Our previous multicentre study showed that the median plasma EFV concentration increased gradually over 48 weeks and that 43.8% of patients had an EFV concentration > 4 mg/L in China [11]. This result meant that HIVinfected Chinese adults were likely to suffer from neuropsychiatric symptoms. It was necessary to choose a suitable dosage of EFV for Chinese patients to improve their treatment safety
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